De Lutio di Castelguidone Elisabetta, Pinto Antonio, Merola Stefanella, Stavolo Ciro, Romano Luigia
Dipartimento di Diagnostica per Immagini, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Naples.
Radiol Med. 2005 Mar;109(3):252-9.
To assess the role CT in the evaluation of traumatic and spontaneous oesophageal perforation.
From March 2001 to May 2003, we studied 12 patients (7 males and 5 females; age range: 25-66 years, mean age: 43.5 years) with suspected oesophageal perforation due to motor-vehicle accidents (4 cases), stab wound (one case), post-intubation (2 cases), foreign body ingestion (2 cases) and spontaneous (3 cases). Five patients underwent standard chest and cervical radiography; two patients with suspected foreign body ingestion also underwent a gastrografin swallow study; all of the 12 patients underwent CT of the neck, chest and abdomen before and after intravenous, and in four cases oral, administration of contrast material.
In 5 patients with cervical, thoracic and abdominal trauma, the CT examination showed the presence of pleuroparenchymal injury (pneumothorax, pleural effusion and subcutaneous emphysema) as well as findings suggestive of oesophageal perforation: peri-oesophageal air (5 cases), peri-oesophageal fluid (4 cases), oesophageal wall thickening (3 cases), oesophageal wall laceration (2 cases) with abnormal course of the nasogastric tube in one of them and extraluminal extravasation of oral contrast material (2 cases). In 2 patients with post-intubation complications, CT showed the presence of a small peri-oesophageal fluid collection containing small gas bubbles in one case, and a gross perioesophageal abscess-like collection in the second case. In the 2 patients with foreign body ingestion, the plain radiography associated with CT showed the presence of a thin metal object in the cervical region (fragment of a dental plate) and a small extraluminal extravasation of gastrografin in one case, whereas in the other case CT showed the presence of a foreign body (chicken bone) in the hypopharynx with oesophageal wall thickening and peri-oesophageal oedema. In the remaining three patients with suspected spontaneous oesophageal perforation, CT showed the presence of a intramural haematoma in one case, oesophageal fluid distension with gas and a small peri-oesophageal fluid effusion (Mallory-Weiss syndrome) in another, and oesophageal rupture (Boerhaave syndrome) in the last case.
Our experience shows that in patients with suspected traumatic and spontaneous oesophageal perforation, standard cervical and chest radiography may suggest a suspected oesophageal perforation in only a small proportion of cases, whereas oral contrast oesophagography has a higher sensitivity. Through the careful analysis of suggestive and specific signs of oesophageal perforation, a correct CT examination enables an accurate and timely diagnosis which significantly affects prognosis and provides valuable indications for treatment.
评估CT在创伤性和自发性食管穿孔评估中的作用。
2001年3月至2003年5月，我们研究了12例疑似食管穿孔患者（7例男性，5例女性；年龄范围：25 - 66岁，平均年龄：43.5岁），病因包括机动车事故（4例）、刺伤（1例）、插管后（2例）、异物吞食（2例）和自发性（3例）。5例患者接受了标准的胸部和颈部X线检查；2例疑似异物吞食患者还进行了泛影葡胺吞咽造影检查；所有12例患者在静脉注射造影剂前后，以及4例口服造影剂后，均接受了颈部、胸部和腹部CT检查。
在5例有颈部、胸部和腹部创伤的患者中，CT检查显示存在胸膜实质损伤（气胸、胸腔积液和皮下气肿）以及提示食管穿孔的表现：食管周围积气（5例）、食管周围积液（4例）、食管壁增厚（3例）、食管壁撕裂（2例），其中1例伴有鼻胃管走行异常，以及口服造影剂管腔外渗漏（2例）。在2例插管后并发症患者中，CT显示1例有小的含小气泡的食管周围液体积聚，另1例有巨大的类似食管周围脓肿的积聚。在2例异物吞食患者中，X线平片联合CT显示颈部有一薄金属物体（牙托碎片），1例有少量泛影葡胺管腔外渗漏，而另1例CT显示下咽有一异物（鸡骨），伴有食管壁增厚和食管周围水肿。在其余3例疑似自发性食管穿孔患者中，CT显示1例有壁内血肿，另1例有食管内液体扩张伴气体及少量食管周围液体渗出（马洛里 - 魏斯综合征），最后1例有食管破裂（博赫哈夫综合征）。
我们的经验表明，在疑似创伤性和自发性食管穿孔的患者中，标准的颈部和胸部X线检查仅在一小部分病例中提示疑似食管穿孔，而口服造影剂食管造影检查敏感性更高。通过仔细分析食管穿孔的提示性和特异性征象，正确的CT检查能够准确及时地做出诊断，这对预后有显著影响，并为治疗提供有价值的指征。
